Topic

Insurance Approval

A collection of 2664 issues

How to Get Cabometyx (Cabozantinib) Covered by Humana in Ohio: Complete PA Guide and Appeals Process

Quick Answer: Cabometyx (cabozantinib) requires prior authorization from Humana in Ohio. Your oncologist must submit clinical documentation including diagnosis, staging, prior therapies, and medical necessity justification. If denied, you have 65 days to appeal internally, then can request external review through Ohio's Department of Insurance. Start by having

How to Renew Epidiolex (Cannabidiol) Coverage with Aetna CVS Health in Florida: 2024-2025 Timeline and Requirements

Answer Box: Epidiolex Renewal with Aetna CVS Health in Florida Aetna CVS Health requires annual prior authorization renewal for Epidiolex for patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Start your renewal 60 days before expiration to avoid gaps. You'll need documented clinical response (seizure reduction)

How to Get Cabometyx (Cabozantinib) Approved by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in North Carolina Cabometyx (cabozantinib) requires prior authorization from UnitedHealthcare/OptumRx for all indications. The fastest path to approval: (1) Verify your plan covers specialty drugs through OptumRx, (2) Submit the UnitedHealthcare Cabometyx PA form with complete clinical documentation including diagnosis, prior therapies,

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Michigan: Appeals, Copay Programs & Prior Authorization

Quick Answer: Getting Tysabri Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through their Provider Portal or by calling 888-397-8129. If denied, you have internal appeal rights followed by Michigan DIFS external review within 127 days. First step today: Have your doctor submit a prior authorization

How Long Does It Take to Get Signifor LAR (Pasireotide) Approved by Humana in New York? Timeline & Appeal Process

Answer Box: Getting Signifor LAR Covered by Humana in New York Timeline: Humana Medicare Advantage must decide on Signifor LAR (pasireotide) prior authorization within 7 calendar days (standard) or 72 hours (expedited) starting January 2026. Currently, most electronic submissions get responses within one business day. Fastest path: Submit complete documentation

How to Get Synagis (Palivizumab) Covered by Aetna CVS Health in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Synagis Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Synagis (palivizumab) and only covers it when Beyfortus is contraindicated, not tolerated, or ineffective. Your child must meet strict high-risk criteria: premature infants <29 weeks and <12 months old,

How to Get Natpara Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Natpara Covered by Blue Cross Blue Shield in North Carolina Important Update: Natpara manufacturing ended December 2024, with the Special Use Program ceasing December 31, 2025. New patient requests are typically denied due to discontinued availability. For existing patients transitioning off Natpara, focus on documenting medical necessity

How to Get Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in Illinois: Prior Authorization, Appeals, and State Rights

Answer Box: Your Fastest Path to Approval Getting Naglazyme (galsulfase) covered by Blue Cross Blue Shield of Illinois requires prior authorization with confirmed MPS VI diagnosis and specialist oversight. Illinois law prohibits step therapy for formulary drugs (effective January 2025), but standard PA still applies. If denied, you have 60

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Evkeeza Coverage Getting Evkeeza (evinacumab-dgnb) covered by Aetna (CVS Health) in North Carolina requires prior authorization and documented failure of standard therapies. The fastest path: ensure your doctor submits comprehensive documentation of HoFH diagnosis, failed statin/ezetimibe/PCSK9 inhibitor trials, and current LDL-C levels via

Getting Hetlioz LQ (Tasimelteon) Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: How to Get Hetlioz LQ Covered by Cigna in Michigan Fastest path to approval: Submit prior authorization with confirmed Smith-Magenis Syndrome genetic testing, documented melatonin failure, and weight-based dosing rationale. If denied, file internal appeal within 180 days, then external review with Michigan DIFS within 127 days. Start